PB2363: REPORTING LANGUAGE IN HAEMATOLOGICAL MALIGNANCIES
Authors: S. Watt, S. Ralston, A. Evans-Tomlinson, J. Burthem
Journal: HemaSphere (2022)

Background: With haematology diagnostics being centralised over the past ten years in the UK and increasingly complex diagnostic pathways, it is important that the treating clinicians and reporters are speaking the “same language” in order that optimal treatment for patient can be achieved. We have reviewed the literature and there are studies looking at language use in general pathology, but to our knowledge nobody has looked at the language used in haemato-pathology reporting, in particular the descriptive terms around diagnoses. Sometimes the language used by reporters reflects the uncertainty in the diagnosis due to atypical appearances or other tests not being consistent, the fact that tests are incomplete or clinical information is missing from the referral. Service users may prefer more unequivocal language to definitively guide management. Supplementary communication in addition reports was often utilised to contextualise findings. Aims: We decided to review the language used in our regional haemato-oncology service Methods: We collected the most commonly used terms from the combined marrow smear and trephine morphology, flow cytometry, molecular and conventional genetics reports at our regional service. We then designed a survey to determine a percentage score for how certain a diagnosis was if it was preceded by the 8 commonly used descriptive terms: ‘suspicious of’, ‘compatible with’, ‘diagnostic of’, ‘suggestive of’, ‘in keeping with’, ‘consistent with’, ‘features are those of’ and ‘cannot be excluded’. Participants were also asked to rank the terms according to their certainty and to express if the term had more weighting if it was for a positive diagnosis or that of a remission. The was also a free text section for participants to express any terms they particularly liked or disliked. We asked both reporters and service users to complete the survey. Results: A total of 47 surveys were returned including 33 who described themselves as reporters and 14 who described themselves as service users. The mean percentage certainty was calculated for all responders as well as for the service user and reporter groups. The range was also calculated for these respective samples. We found that “diagnostic of” scored overall highest for degree of certainty at 97.8% and “cannot be excluded” lowest at 29.9%. The most interesting aspect was the large range of results in “suspicious of” and “cannot be excluded” where there was 70 percentage points between the highest and lowest answers. An unpaired t-test showed that for “suspicious of” and “compatible with” there was a statistically significant difference in mean certainty between reporters and service users. The largest difference between reporters and users was “suspicious of” with reporters rating 14% higher, 59% v 45%. Image:Summary/Conclusion: The survey shows how perceptions of reports can differ markedly between individual reporters and service users. This demonstrates the importance of the MDT in ensuring pathologists play an active role in the diagnosis and that their reports are not misinterpreted. Pathology services should try to standardise their language to reduce the amount of ambiguity in their reports. We would be very interested to see if these differences are replicated in other diagnostic services both within the UK and also in other languages. The next step in this project is to gather a focus group and gain more in-depth qualitative data. This would be to discuss not only the terms used in the questionnaire, but the wider themes of communication previously described.